Flashcards in Required Reading-Preop/Airway Deck (51):
Majority of anesthetic complications are due to ___ injuries; these result from ____.
respiratory; difficult intubation, difficult airway, poor dentition
Factors affecting mask ventilation (5)
(1) Beard (2) BMI>26 (3) Missing teeth (4) Age>55 (5) Snoring
Determine preop CV functional capacity with _____. A score of greater or equal to ____ have better periop outcomes in NONcardiac surgery.
metabolic equivalent [MET] activity; 4 [raking leaving, weeding or pushing power mower; MET scores 1-12]
If sx not urgent, then active cardiac condition/clinical risk factors should be assessed preop. If cleared, low-risk sx have
endoscopic procedures, superficial procedures, cataract, breast, most ambulatory surgeries
Intermediate-risk sx for CV include ____. High-risk sx include ____
intraperitoneal, intrathoracic, carotid endarterectomy, head/neck, orthopedic; aortic, major vascular, peripheral vascular
Patients with a MET
heart rate control; cardiac testing
Pulmonary patient-related periop risks:
smoking, poor general health (ASA>2), age>70, obesity, COPD, reactive airway dz (asthma)
Pulmonary PROCEDURE-related periop risks:
surgery >3hr, gen anesthesia, type of sx, pancuronium
Risk reduction for pulmonary risks (A) preop (B) periop (C) postop
(A) smoking cessation for 8wks, tx COPD/asthma, Abx for URI, incentive spirometry (B) limit
Important to remember that hepatic dysfunction can cause ____ and ____.
altered coagulation; altered drug pharmacokinetics
GI dz can increase potential of ____, ____, ____ and ___.
aspiration; dehydration; electrolyte disturbances; anemia
All diabetics should be evaluated for ____, ____ and _____. Most docs will avoid ___ anesthesia due to peripheral neuropathy.
CAD, HTN, nephropathy (Cr levels); regional
Diabetics need to take ___ of morning dose insulin on day of surgery; if elective, should do earlier in day to avoid _____.
half; prolonged fasting
Physical exam consists of vitals, airway eval, cardiopulm, GI, MSK and neuro exam. Airway exam assesses ___
Mallampati score, facial trauma, large incisors, beard, large tongue, neck masses, tracheal deviation, thyromental distance (
Important to look at chronic pain and ___ use, because may lead to increased requirements during surgery. Also look for long-term ___ use, which can lead to ____ and may require supplementation during sx.
opioid; steroid; adrenal insufficiency
Supplements: ___ and ___ can potentiate anticoagulation meds, ___ can prolong anesthesia, ___ can cause arrhymias
ginko; garlic; St Johns Wort; Ephedra
Poss preop studies and indicated dz: (A) CBC (B) T/S & albumin (C) PT/PTT (D) Electrolytes
(A) CBC; EtOH, anemia, radiation therapy, etc. (B) T/S & albumin; hematologic dz, malnutrition (C) PT/PTT; hepatic dz, Fhx bleeding, anticoag (D) Electrolytes; renal dz, DM, etc.
Poss preop studies and indicated dz: (E) BUN/Cr (F) Glucose (G) AST/ALP (H) EKG (I) CXR
(E) BUN/Cr; cancer w/ chemo, renal dz, digoxin/diuretics (F) Glucose (G) AST/ALP; EtOH, cancer w/ chemo, statins (H) EKG; statins, digoxin, radiation, etc. (I)CXR; smoking hx, radiation therapy, rheumatoid arthritis, etc.
The purpose of the ____ is to discuss w/ pt or rep the types of anesthetic options available for planned procedure and explain risks/benefits
anesthesia consent form
ASA Class ___ is a normal and healthy patient
ASA Class ___ is a pt w/ mild systemic dz
ASA Class ___ is a pt w/ severe systemic dz that limits activity, but is a constant threat to life
ASA Class ___ is a pt w/ incapacitating system dz that is constant threat to life
ASA Class ___ is moribund pt not expected to survive 24h w/ or w/o sx
ASA ___ designates emergency surgical procedure
If a pt is perceived as difficult to intubate/ventilate, obtain ____.
fiberoptic equipment and skilled help
If pt has heart dz/valve dz or risk of subacute bacterial endocarditis, consider ____ 1h prior to sx
If pt Fhx malignant hyperthermia, have ___ ready
If pt on MAOIs, discontinue therapy preop if pt not ____ and plan for periop pain therapy
If pt has peripheral motor neuropathy, avoid _____ drugs
depolarizing muscle relaxants
If pt pregnant, use ____
oral antacids [monitor FHTs]
Types of anesthesia are __, ____, ___ and ___
general, MAC (monitored anesthesia care), regional, local
The best way to assess CV risk is asking about ____
DO NOT quit smoking w/in a short period before sx because will increase ___ and ____ temporarily. Must try to quit greater than ___ weeks preop.
coughing; sputum production; 8
Difficult laryngoscopy is defined as when no portion of ____ is visualized.
glottis (vocal cords and space)
Medical conditions that portend difficult airway include ___
hx facial trauma/sx, rhuematoid arthritis, pregnancy, epiglottitis, previous cervial fusion, neck masses, Down's syndrome, Treacher-collins, Pierre-Robin abnormalities
Increasing difficult laryngoscopy correlated with Mallampati Class ____ and ___
Mask ventilation needs optimal ____, ____ visualized as pt in "sniffing" position, and sufficient ____ to overcome resistance of upper airway.
seal; oropharynx; positive pressure
Mask ventilation is to augment a pt's spontaneous ____ before definitive airway management.
___ can be used in pts receiving gen anesthesia w/ no endotracheal intubation and in situations when mask vent is difficult.
LMA does NOT enter the _____, therefore pts tolerate it with less anesthetic; also, LMA does NOT protect against ____ to same degree.
glottis; pulmonary aspiration
Contraindications to LMA include ___, ____, ____ and ___
increased risk pulmonary aspiration; pts w/ PEEP ventilation; long procedures; any position other than supine
Common errors in direct laryngoscopy include ____ and ____
inserting blade too deeply; improperly sweeping tongue from line of signt
MC laryngoscope blades are ____ [curved} and ____ [straight]
Because of anatomical narrowing at level of cricoid cartilage in children ____ tubes are used and a seal forms directly between tube and trachea.
Endotracheal intubation is gold standard b/c reduces possibility of ____ and increases amount of ____ that can be achieved via mech ventilation.
aspiration via gastric juices; positive airway proessure
Risk factors for aspiration have to do with having eaten and include :
trauma pts, emergency sx (not fasting), pregnant pts in labor, GERD, DM/obesity, neurological impairment
In order to dec time when pt awake (intact laryngeal m protecting from aspiration) and endotracheal tube, a ____ can be done.
RSI (rapid sequence induction)
Rapid sequence induction does NOT use ____ (avoiding stomach distention), ____ pressure is maintained , and ___ is muscle relaxant drug of choice
mask ventilation; cricoid [surrounds trachea and will collapse esophagus lumen]; succinylcholine [rocuronium if burn or SC injury pts]
Fiberoptic intubation can be accomplished in ____/____ patients.
awake [w/ local anesthesia]; anesthetized